PERSONAL HEALTH

PERSONAL HEALTH; A SIMPLE, 30 SECOND EXAMINATION CAN HELP DETECT TESTICULAR CANCER

By Jane E. Brody

Published: March 18, 1981

RONALD was 25 years and the father of a 2-month-old when he noticed a small lump on his right testicle. At his wife's insistence he called his doctor, who sent him to a urologist at a leading cancer center.

The urologist's recommendation -that the testicle be removed without delay since it was probably cancerous - was profoundly disturbing to Ronald and his wife. It was two days before the rest of what the doctor had said sank in: ''You have better than an 85 percent chance of being cured without any loss of your sexual ability. Chances are your fertility will also remain intact.''

After surgery Ronald underwent two years of therapy with strong drugs that made him miserable at times, though he was able to work through most of it. That was four years ago. Now, about to become a father again, Ronald is living testimony to the progress against certain cancers and to the value of ''aggressive'' therapy at a center that specializes in treating the disease.

Ronald's story also underscores the value of a simple 30-second self-examination that can detect testicular cancer at an early stage, when treatment is less complicated, according to Dr. Robert B. Golbey of Memorial Sloan-Kettering Cancer Center in New York. Yet, he adds, many men do not examine themselves because ''they're afraid of what they might find.''

Though testicular cancer is quite rare, accounting for only about 1.5 percent of cancers, it is the most common solid tumor in men in the prime of life, striking 7 or 8 of 100,000 men aged 20 to 34. This year 5,100 to 5,200 cases will be diagnosed among Americans, nearly all younger than 40.

From all appearances the disease is increasing, for reasons that are not yet clear, but factors known to raise the risk of testicular cancer are well defined:

- An undescended testicle. The cancer occurs in as many as 5 percent of men with one testicle that has remained in the abdominal cavity instead of descending into the scrotal sac. If a testicle has not descended on its own, it should be brought down surgically between the ages of 2 and 3, and certainly before age 6, the experts say.

- Exposure to X-rays before birth. The risk is nearly doubled if a mother has abdominal or pelvic X-ray during pregnancy. In addition, there is some evidence that treatment with DES (diethylstilbestrol) or related hormones during pregnancy may expand the risk of abnormalities, including cancer, in the genitourinary tracts of male offspring.

The hormone treatment, once given to millions of women in hopes of forestalling miscarriage, can cause vaginal cancer and other abnormalities in females exposed prenatally. The experts recommend that males similarly exposed be checked on a regular basis.

Self-examination for testicular cancer is done during or right after a warm shower or bath since heat relaxes the scrotum wall, making the detection of deformities easier. While standing, place the right thumb on the outside and the rest of the fingers on the back side of the right testicle, rolling it between thumb and fingers; repeat the procedure on the left side.

The testicles should feel the same and be approximately the same size (it is normal for one testicle to hang lower). A normal testicle is oval and firm but not hard and has a regular surface. Detectable just above the testicle are blood vessels, the spermatic cord suspending the testicle and the epididymis, a tube that transports sperm from the testes to the urethra.

After one or two examinations, you should be able to detect abnormal changes - a discrete hard lump, a diffuse thickening, overall enlargement. Repeat the self-examination once every four to six weeks. Do not delay asking a doctor to check anything unusual.

Dr. Marc Garnick, director of the genitourinary program at the Sidney Farber Cancer Institute in Boston, stresses that prompt attention to abnormalities is particularly important since 95 percent of those that are not infections are cancer. Be especially wary of abnormalities that do not hurt since infections tend to be painful while cancer is not, at least not at first. As the cancer grows and spreads, symptoms may include a tugging sensation in the groin, back pain and nipple tenderness or milk from the breasts.

Dr. Garnick tells of a 24-year-old who walked around with a testicular lump for seven months after he noticed it. His explanation was that it did not bother him so he did not pay any attention to it. By the time he got medical help, his testicle was four times normal size and the cancer had spread elsewhere. Though cure is still possible, the treatment at that stage is far more complicated and hazardous than it might otherwise have been.

Treatment of any suspicious lump on the testicle involves, first of all, surgery through the groin to remove the testicle, leaving the scrotal sac intact. (A needle biopsy or a cut through the scrotum should never be done because it could spread cancer to other areas, the experts warn.) The type of cancer involved - seminoma or nonseminoma, indicating the tissue of origin-determines treatment and outlook.

A diagnosis of cancer should be followed by a series of tests to determine if and where the cancer has spread. Tests may include a chest X-ray, abdominal CT scan and ultrasound examination, blood tests and an X-ray of the lymph glands.

The prognosis these days is good for all testicular cancers. A dozen years ago fewer than 10 percent of men with nonseminoma that had spread to the lungs were alive two years after diagnosis; today 85 to 90 percent are alive and cured, Dr. Garnick says, attributing the difference primarily to various combinations of drugs after surgery. Patients with advanced disease may be hospitalized for the intensive treatment, which lasts 12 weeks. In some cases maintenance treatment with lower doses continues for two years.

For seminomas, treatment involves radiation therapy after surgery. About 95 percent of seminomas that have not spread beyond the testicles and 80 percent of those that have spread to the abdomen can be cured with radiation, according to the specialists, while in more advanced cases chemotherapy plus radiation can be used.

Since testicular cancer is an uncommon disease, many doctors are unfamiliar with recent advances in diagnosis and treatment. The best therapy can be obtained in centers where relatively large numbers of cases are seen, including the Sidney Farber Institute, Memorial Sloan-Kettering in New York, the Indiana University School of Medicine in Indianapolis, M.D. Anderson Hospital in Houston, the University of Minnesota Hospitals in Minneapolis and, in Los Angeles, the University of California and University of Southern California.

Because the treatment may impair fertility, some patients who may want to have children later ask about sperm banking. However, Dr. Garnick points out, sperm banks are few and far between and the likelihood of recovering viable sperm is only 10 percent or less.

Psychological problems after treatment for testicular cancer seem to be infrequent. Young patients may request a testicular prosthesis.